Reviewer: Mary Kara Bucci, MD
University of Pennsylvania Cancer Center
Last Modified: December 9, 2001
Presenter: David G. Maloney
Presenter's Affiliation: Fred Hutchinson Cancer Research Center, Seatle, WA
Type of Session: Plenary
Myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for Multiple Myeloma has been associated with high transplant-related mortality (TRM), limiting its clinical usefulness despite its potential for cure. Autologous HSC rescue has a lower rated of TRM but does not have the curative potention of the graft-vs-tumor effect of the allograft. In order to combine the curative potential of allogeneic HSCT with the safety of autologous HSC rescue, this study followed a myeloablative autolgous HSCT with immunosuppression and an allogeneic HSC rescue, separating the high-dose conditioning regimen from the graft-vs-tumor inducing allograft by 40-120 days.
Materials and Methods
42 patients with relapsed or refractory Stage II/III myeloma received 200mg/m2 of melphalan and autologous SCR, followed 40-120 days later with a single fraction of 200 cGy total body irradiation, immunosuppression with mycophenylate mofetil x 28 days and cyclosporine at least 56 days and unmodified allogeneic stem cell transplant with peripheral blood stem cells from an HLA-identical sibling. The initial 4 patients received allografts of CD 34+ cells only; after the death of 1 patient from cytomegalovirus pneumonia, allografts were modified to CD34+ cells(8.6 x 106) and CD3+ cells (4.2 x 108).
This novel combined approach to stem cell transplant may offer a safer, potentially curative treatment option for multiple myeloma patients. Older patients, who traditionally have not been offered allogeneic transplant for multiple myeloma due to their increased risk of treatment-related morbidity and mortality may be suitable candidates for this regimen.
Oncolink's ASH Coverage made possible by an unrestricted Educational Grant from Amgen.
Mar 2, 2015 - Despite the emergence of novel agents to treat multiple myeloma, a combination of high-dose therapy and autologous hematopoietic stem-cell therapy continues to be the best initial treatment, according to an article published in the June 18 issue of the New England Journal of Medicine.
May 3, 2012
Mar 2, 2015